MICROSCOPIC

How many mL of urine is used for Urinary Sediment Preparation

How many mL of urine is used for Urinary Sediment Preparation

10-15 mL

Average mL of urine for Urinary Sediment Preparation

12 mL

For Urinary Sediment Preparation, urine should be centrifuged at how many RCF and for how long

400 RCF for 5 minutes

When decanting urine, how much is remained?

0.5-1.0 mL

A quantitative measure of formed elements of urine using hemocytometer

Addis count

Specimen used for Addis count

12-hour urine specimen

Preservative used for Addis count

Formalin

Normal values in Addis count

500,000/12-hour urine

Normal values of WBCs and epithelial cells in Addis count

1-1,800,000/12-hour urine

Normal value of Hyaline cast in Addis count

0-5,000/12-hour urine

This type of microscope is the most commonly performed in urinalysis laboratory; also used in routine urinalysis

Bright Field Microscopy

TRUE OR FALSE. When using Bright Field Microscopy, objects appear light against dark background.

FALSE

This type of microscopy enhances visualization of translucent elements and works by retardation of light rays diffused by the object involved

Phase Contrast Microscopy

What kind of effect does Phase Contrast Microscopy possess?

Halo effect

This type of microscope identified cholesterol in oval fat bodies, fatty casts and crystals.

Polarizing Microscopy

In polarizing microscopy, what pattern is produced in cholesterol?

Maltese cross

Dark Field Microscopy is useful for the identification of?

Treponema pallidum

This type of microscope is used for the visualization of fluorescent microorganisms or those stained by fluorescent dye

Fluorescence Microscopy

This type of microscopy is used for 3D microscopy image and layer by layer imaging of specimen

Interference Contrast Microscopy

What is the most frequently used stain in urinalysis?

Sternheimer-malbin (Crystal violet + Safranin O)

This delineates structure and contrasting colors of the nucleus and cytoplasm

Sternheimer-malbin

What does Sternheimer-malbin identifies?

WBCs, epithelial cells, casts

This enhances nuclear detail; supravital stain

Toluidine Blue

Toluidine blue differentiates what?

WBC and RTE cells

This lyses RBCs when added to urine sediments; enhances nuclei of WBCs (appears clear)

2% Acetic Acid

2% Acetic Acid distinguishes RBCs from?

WBCs, yeasts, oil droplets, crystals

This stains triglycerides and neutral fats

Lipid stains (Oil Red and Sudan III)

What is not stained in Lipid stains?

Cholesterol

What color is produced when Lipid stains is used?

Orange red

What does lipid stains identify?

Free fat droplets and lipid containing cells and casts

This differentiates gram positive and gram negative bacteria

Gram stain

Gram stain identifies what?

Bacterial cast

What stains eosinophilic granules?

Hansel stain (Eosin Y + Methylene blue)

Color of Eosin Y

Red

Hansel stain identifies what?

Urinary eosinophils

Increased urinary eosinophil may indicate what?

Interstitial nephritis

This stains structures containing iron

Prussian blue

What does Prussian blue identifies?

Hemosiderin granules in cells and casts

Normal value of RBCs in urinary sediments

0-2 or 0-3/HPF

In this type of urine, RBCs may crenate or shrink

Hypertonic urine

In this type of urine, RBCs may swell or hemolyze

Hypotonic urine

Dysmorphic with projections and fragmented RBCs can cause you to have what kind of damage?

Glomerular Membrane Damage

What are sources of error in the RBCs?

Yeast, Oil droplets, air bubble, calcium oxalate crystals

What is a way to distinguish RBC accurately?

Add 2% Acetic Acid

Increased numbers of WBCs in urinary sediments may indicate presence of what?

Urinary Tract Infection or Inflammation

Normal value of WBC in urinary sediments

0-1 or 0-2/HPF

Appearance of Neutrophils

Granulated and multi-lobed

Appearance of Eosinophils

Multi-lobed nucleus

Normal value of Eosinophils

1%

Eosinophils is associated with what kind of disease?

Drug-induced interstitial nephritis

These are lymphocytes, monocytes, macrophages, histiocytes that are seen in small amounts in urinary sediments

Mononuclear cells

This is the largest cell with abundant, irregular cytoplasm and prominent nucleus

Squamous Epithelial Cells

Squamous epithelial cells can be found from?

Linings of vagina, female urethra, lower portion of male urethra

Squamous epithelial cells has a variation which is known to be the abnormal type of squamous epithelial cells

Clue cells

Squamous epithelial cell covered with G. vaginalis is associated with?

Bacterial vaginosis

These are spherical, polyhedral or caudate with centrally located nucleus

Transitional Epithelial Cells

Transitional epithelial cells can be found from?

Lining of renal pelvis, ureter, urinary bladder, upper portion of male urethra

Increased numbers of Transitional epithelial cells are seen in?

Catheterization

Transitional Epithelial cells are commonly seen in patients with?

Chronic Kidney Disease and dialysis

This is the most clinically significant epithelial cell

Renal Tubular Epithelial Cells

The cytoplasm of RTE cells are?

Coarsely granular

Origin of RTE cells

Nephron

They are rectangular, polyhedral, cuboidal or columnar with an eccentric nucleus

Renal Tubular Epithelial Cells

2 RTE/HPF indicates?

Tubular injury

These are lipid containing RTE cells

Oval Fat Body

These are RTE cell with non-lipid filled vacuoles

Bubble cells

Bubble cell are seen in?

Acute Tubular Necrosis

Oval Fat body are usually seen in?

Lipiduria

Bacteria + WBC indicates?

Urinary Tract Infection

This is the most common cause of UTI

Enterobacteriaceae (Escherichia coli)

What does it mean when only bacteria is found in the urine sediment?

Old specimen, normal flora, contamination

Yeast + WBC indicates

True Yeast Infection

These are small, refractile oval structures that may or may not bud

Yeast

These are seen in vgainal moniliasis

Candida albicans

What does it mean when only yeast is found in the urine sediment?

Contamination, normal flora

Yeast are commonly seen in px with?

Diabetes mellitus

Parasites commonly seen in urinary sediments

Trichomonas vaginalis, Schistosoma haematobium ova, Enterobius vermicularis

These are usually seen after sexual intercourse

Spermatozoa

Major constituent of Mucus thread

Tamm-Horsfall protein

This is a prototype cast and is the beginning of all types of casts

Hyaline cast

Normal value of Hyaline cast

0-2/LPF

Hyaline cast may be physiologically due to?

Stress and strenuous exercise

Hyaline cast may be pathologically due to?

Glomerulonephritis, pyelonephritis, congestive heart failure

Presence of RBC casts may be due to?

Bleeding within the nephron, Glomerulonephritis, Strenuous exercise

Presence of WBC casts may be due to?

Inflammation within the nephron, Pyelonephritis, Acute Interstitial nephritis

WBC cast may be confused with?

Epithelial Cell cast

To differentiate WBC cast from epithelial cell cast

Phase microscopy and supravital stain

Only ______ stick to the cast because they are both in the kidney

Renal Tubular Epithelial Cells

Presence of RTE cell casts may be due to?

Advanced Tubular Destruction, Renal Tubular Damage

Bacterial casts can resemble?

Granular casts

Presence of Bacterial casts may be due to?

Pyelonephritis

Granules are derived from the _____ during normal metabolism

Lyososomes of the RTE cells

Presence of Granular casts casts may be due to?

Glomerulonephritis, pyelonephritis, stress, strenuous exercise

Fatty casts are not stained with?

Sternheimer-malbin stain

Final degenerative form of all types of cast. Brittle, highly refractive with jagged ends

Waxy cast

Stasis of urine flow of Waxy cast

Chronic Renal Failure

Broad cast is also known as?

Renal Failure Cast

This indicates destruction (widening of the tubular walls; extreme urine stasis, renal failure

Broad cast

These are acid, yellow brown, rosette and wedge shaped

Uric Acid

Acid, brick dust or yellow brown

Amorphous urates